Radiology Faculty--Answering Questions/"AMA"

[Gibbwil]

Hey RadiologyPD!

I apologize if you've mentioned this in the thread previously, but any advice to those applying rads after an unsuccessful match in an alternate specialty the cycle before? Currently doing a TY, failed to match PM&R last cycle. I have a brief blurb about it in my PS, but most of my application is still geared towards PM&R still. I even have some ongoing projects that are PM&R-focused because I enjoy them. Thanks!

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[Dro133]

Hi RadiologyPD, thanks for taking the time to answer these questions.

How big of a red flag is being in the bottom quartile of my class for clinical grades, assuming no other red flags?

 

[RadiologyPD]

Hey RadiologyPD!

I apologize if you've mentioned this in the thread previously, but any advice to those applying rads after an unsuccessful match in an alternate specialty the cycle before? Currently doing a TY, failed to match PM&R last cycle. I have a brief blurb about it in my PS, but most of my application is still geared towards PM&R still. I even have some ongoing projects that are PM&R-focused because I enjoy them. Thanks!

No special advice. Obviously be prepared to speak to why Radiology, and be sure that the PS is clear in this regard.

Hi RadiologyPD, thanks for taking the time to answer these questions.

How big of a red flag is being in the bottom quartile of my class for clinical grades, assuming no other red flags?

I hate to say it, but it depends on how good your board scores were, in several ways. When you say "no other red flags", I presume then that the board scores are at least average for radiology applicants (so, in fact, above average).

First, some programs may be so focused on Board scores that they don't really recognize the bottom quartile class rank performance, so if the Board scores were good, you'll get through to the interview.

A rare program may see that your Board scores were good and wonder how you managed to be in bottom quartile of the class despite that--so then it will sort of depend on the rest of the MSPE and the perceived "rank" of the school.

 

[Ahockey28]

Hi PD! I am an R-2/PGY-3 and love my program. Life happens and I'm married with 2 kids now looking for some family support. A program in my home city said they would "consider me" if I "make sure my funding transfers with me"... What does that mean?!

I hope it does not mean that if I leave they expect my current program to give up a funded slot and be 29 instead of 30 in the compliment.

Also any advice on not upsetting my PD when I inquire would be greatly appreciated. Thats the last thing I want to do. @RadiologyPD

 

[RadiologyPD]

Hi PD! I am an R-2/PGY-3 and love my program. Life happens and I'm married with 2 kids now looking for some family support. A program in my home city said they would "consider me" if I "make sure my funding transfers with me"... What does that mean?!

I hope it does not mean that if I leave they expect my current program to give up a funded slot and be 29 instead of 30 in the compliment.

Also any advice on not upsetting my PD when I inquire would be greatly appreciated. Thats the last thing I want to do.

Many residents are actually "funded" by Medicare, essentially. It depends on the institution and whether or not they had their full complement of residents in place by 1998, since that's when this was frozen--meaning if there was an institution in New York state that had 100 "federally funded" residents in 1998, then this institution still has 100 federally funded residents today. If that institution hasn't increased the number of residents in their entire organization, then the allotment that the institution allocates to the DR program is usually the same.

Believe it or not, this is essentially "free labor" for those programs/institutions. Which is why you never see one of them voluntarily downsize--they aren't paying for their residents.

The institution could decide to allocate their funds to another program. That happened when St. Barnabas (an osteopathic diagnostic residency) "closed down" in 2013--the slots that the institution had allocated to DR were reallocated to another residency at the organization. The entire institution gets to keep all 100 slots. it turns out, the federal government actually pays an institution more for primary care residents than radiology residents, so there is a bit of an incentive for organizations to tweak their programs to favor primary care.

In comparison, some of the programs that have been increased or developed since 1998 have residents who are paid for by the organization, not the federal government. So, for example, if a program in Colorado develops an IR residency or increases their DR residency since 1998 (because Colorado is growing), the funding for this increase in residents has to come from the organization, or from a reallocation of slots from other programs at that institution.

So...what the "home city program" is saying is that if you are funded by the government, they will take you as free labor if the residency that you are leaving is willing to "go without" for your spot--give up your funding commitment from the government and transfer to them for the duration of your residency (as you said, go with 29 residents instead of 30). This is what happened to all the Hahnemann residents, they took their funding with them.

It's very unlikely that your current program would make this concession. They would prefer to fill your empty spot with a transfer in, who they would pay with their external funding for you. And if your spot is actually being paid for by the organization, then this transfer would never happen.

As an R2, you have essentially 2 more years after this year--I would figure out another solution to your desire to have family support. Don't even ask your current PD--unless there is an open spot to which you want to transfer. In that case, what your PD might do is let you go (without having to still pay you), then use your funds to get a new resident in the R1 class next year, or a transfer in. Asking your PD if you can go to another program but still be paid for by your current program shows tremendous chutzpah, and not in a good way.

 

[meltingbones95]

My family is full of Radiologists. Do you want to hear about this in my personal statement or does that seem like I am asking for favoritism? There about 8 programs across the country where I could say my father or an uncle trained.

 

[RadiologyPD]

If you want to put into PS, go ahead...might be subliminally influential on a program specific basis if you have a relative who trained there, which would be nice to add. Could be good interview fodder.

 

[RadiologyPD]

I think you are better off discussing why you improved on Step 2 CK, which by definition means you're acknowledging a less than stellar Step 1. It's not like your Step 1 will be under any radar--for better or worse, that's one metric that EVERY applicant has that is standardized (it may be the only metric). If you have some way to suggest to the selection committee that you are actually a reasonably good test-taker and Step 1 is an anomaly, put forth that thesis.

 

[MouseChair]

You may or may not have insight into this. For ESIR candidates, do you care what their prelim year was in? There is a heavy emphasis on surgery as prelim for direct IRDR candidates. But would a medicine year be acceptable? Would a transitional year potentially disqualify you from an ESIR spot, even with ICU experience?

 

[RadiologyPD]

You may or may not have insight into this. For ESIR candidates, do you care what their prelim year was in? There is a heavy emphasis on surgery as prelim for direct IRDR candidates. But would a medicine year be acceptable? Would a transitional year potentially disqualify you from an ESIR spot, even with ICU experience?

I'm not an IR PD, but as the DR PD in our program that has ESIR, I'm involved in vetting the DR residents who want to do IR in our program. I doubt it would matter that much in terms of securing your ESIR spot anywhere; it doesn't for us. Your ability to get an ESIR spot will be based on your relative strength as an "IR person" to the IR decision-makers based on your performance as a DR resident (unless you happen to be at Baylor, where they do the unusual step of matching you to the ESIR spots within their DR program when you are a medical student).

I can't imagine it makes that much of a difference to your skill level as an IR rad, since there are many faculty in IR that did NOT do a surgical internship. Having said that, if you are primarily interested in IR, seems like it would make sense to do a surgical based internship rather than a medicine one. TY seems fine to me, and a good compromise if you can get some experience in things relevant to IR.

 

[spockprime]

@RadiologyPD -- Firstly, thank you so much for your posts here! This is probably the most informative and thoughtful thread I've ever read, and would likely be beneficial to applicants in any specialty. Incredibly insightful. I have a quick question very specific to my own application for you, and was wondering if there is a way to directly message you for a brief opinion? I don't necessarily think my application question would add to the information compiled here, and would prefer to be a little more anonymous than on this thread. However, I know you are very busy so I understand if this is not possible!

 

[NegzDO]

For DR programs, should I submit a mediocre DR over a strong IR letter just for the sake of having a diagnostic letter in there (for my 4th LOR)? The other three letters are also strong (1 IR, 2 Surgery)

 

[RadiologyPD]

Send best (strongest) letters. I care less about who wrote them, unless I know the letter writer.

How important are Radiology letters when applying?

 

[halpmepls]

Hello @RadiologyPD - thank you so much for taking the time to be here. The interview season is finally upon us!

One question I have - and I apologize if something similar has already been asked earlier in this thread - is when should we sending "letters of interest" to programs that we have NOT yet received interview invites from? Should we even bother doing so? Would these messages be best addressed to the program coordinator, program director, both, or someone else? From your experience, do you think these emails make any difference? As far as content goes, do you recommend identifying yourself by board scores/clerkship grades and then diving into a few sentences about why you are interested in the program?

Obviously, I wouldn't be doing this for every program, but rather for a select few, strong programs in certain geographies that I am very interested in.

Also, to piggyback off this question, do you think now is a good time to start taking advantage of my school's list of prior MD students who have matched at programs to which I have just applied (e.g., by reaching out to them so that I can start forming connections)?

Thank you in advance!

 

[RadiologyPD]

One question I have - and I apologize if something similar has already been asked earlier in this thread - is when should we sending "letters of interest" to programs that we have NOT yet received interview invites from? Should we even bother doing so? Would these messages be best addressed to the program coordinator, program director, both, or someone else? From your experience, do you think these emails make any difference? As far as content goes, do you recommend identifying yourself by board scores/clerkship grades and then diving into a few sentences about why you are interested in the program?

Obviously, I wouldn't be doing this for every program, but rather for a select few, strong programs in certain geographies that I am very interested in.

See post #60. Send to PC and cc PD. If your metrics (board scores/other measures) are good, then reference them.

Also, to piggyback off this question, do you think now is a good time to start taking advantage of my school's list of prior MD students who have matched at programs to which I have just applied (e.g., by reaching out to them so that I can start forming connections)?

In my opinion, this will not be of value in getting selected by a program for interview OR for rank list. It could help if you wanted to learn more about the residency from the perspective of the resident who went to your medical school. If that's your intention, then anytime is good.

 

[peachsn0wbubble]

Hello @RadiologyPD,
I'm lucky to be at a TY w a few blocks of elective time, planning for addl research + Step 3, but also wanted to browse some high-yield rads texts before starting R1 next year. Any suggestions for incoming residents? This is in light of the increasing Core exam failure rate that has me concerned.

Thank you for your advice + continued dedication to this thread.

 

[RadiologyPD]

Sorry, not really. I'm completely subspecialty based, and rely on my Division Education Directors to vett the reading materials for our residents. There are some "Fundamentals" books out there, such as Helms Fundamentals of Skeletal Radiology and Webb's Fundamentals of Body CT. Not sure if those are the best though.

I'm sure there are other threads in SDN that would be more helpful. Though I admire and encourage your desire to increase your Radiology knowledge, I don't think it will have any bearing on your Core exam performance.

 

[Ahockey28]

Many residents are actually "funded" by Medicare, essentially. It depends on the institution and whether or not they had their full complement of residents in place by 1998, since that's when this was frozen--meaning if there was an institution in New York state that had 100 "federally funded" residents in 1998, then this institution still has 100 federally funded residents today. If that institution hasn't increased the number of residents in their entire organization, then the allotment that the institution allocates to the DR program is usually the same.

Believe it or not, this is essentially "free labor" for those programs/institutions. Which is why you never see one of them voluntarily downsize--they aren't paying for their residents.

The institution could decide to allocate their funds to another program. That happened when St. Barnabas (an osteopathic diagnostic residency) "closed down" in 2013--the slots that the institution had allocated to DR were reallocated to another residency at the organization. The entire institution gets to keep all 100 slots. it turns out, the federal government actually pays an institution more for primary care residents than radiology residents, so there is a bit of an incentive for organizations to tweak their programs to favor primary care.

In comparison, some of the programs that have been increased or developed since 1998 have residents who are paid for by the organization, not the federal government. So, for example, if a program in Colorado develops an IR residency or increases their DR residency since 1998 (because Colorado is growing), the funding for this increase in residents has to come from the organization, or from a reallocation of slots from other programs at that institution.

So...what the "home city program" is saying is that if you are funded by the government, they will take you as free labor if the residency that you are leaving is willing to "go without" for your spot--give up your funding commitment from the government and transfer to them for the duration of your residency (as you said, go with 29 residents instead of 30). This is what happened to all the Hahnemann residents, they took their funding with them.

It's very unlikely that your current program would make this concession. They would prefer to fill your empty spot with a transfer in, who they would pay with their external funding for you. And if your spot is actually being paid for by the organization, then this transfer would never happen.

As an R2, you have essentially 2 more years after this year--I would figure out another solution to your desire to have family support. Don't even ask your current PD--unless there is an open spot to which you want to transfer. In that case, what your PD might do is let you go (without having to still pay you), then use your funds to get a new resident in the R1 class next year, or a transfer in. Asking your PD if you can go to another program but still be paid for by your current program shows tremendous chutzpah, and not in a good way.

Thank you so much for the response. This is exactly the answer I have been looking for. I would never have asked without this information since I thought it meant that type of concession for my program. Now I definitely will not ask!

Great explanation. Thank you for the time and education!

 

[RadiologyPD]

Many residents are actually "funded" by Medicare, essentially. It depends on the institution and whether or not they had their full complement of residents in place by 1998, since that's when this was frozen--meaning if there was an institution in New York state that had 100 "federally funded" residents in 1998, then this institution still has 100 federally funded residents today. If that institution hasn't increased the number of residents in their entire organization, then the allotment that the institution allocates to the DR program is usually the same.

Believe it or not, this is essentially "free labor" for those programs/institutions. Which is why you never see one of them voluntarily downsize--they aren't paying for their residents.

The institution could decide to allocate their funds to another program. That happened when St. Barnabas (an osteopathic diagnostic residency) "closed down" in 2013--the slots that the institution had allocated to DR were reallocated to another residency at the organization. The entire institution gets to keep all 100 slots. it turns out, the federal government actually pays an institution more for primary care residents than radiology residents, so there is a bit of an incentive for organizations to tweak their programs to favor primary care.

In comparison, some of the programs that have been increased or developed since 1998 have residents who are paid for by the organization, not the federal government. So, for example, if a program in Colorado develops an IR residency or increases their DR residency since 1998 (because Colorado is growing), the funding for this increase in residents has to come from the organization, or from a reallocation of slots from other programs at that institution.

So this is an aside into the world of residency financing. You wouldn't understand what this article is about without the information quoted above.

Judge puts freeze on sale of Hahnemann residency program — for now

Hahnemann had 550 residency spots, funded by Medicare "in perpetuity" (or at least until the rules change, which is really hard to execute).

The residents in those programs took the Medicare funding with them to other programs. So Hahnemann has no incoming Medicare funding for residents for the duration of those residents tenure at other programs (let's say between 1-5 yrs, since anyone in their last year of training will only take the Medicare funding with them to another institution for 1 year, anyone with 2 years left will take the Medicare funding for 2 years, etc).

But Hahnemann (or its creditors) still own the rights to future payments from Medicare for 550 residency positions that they would have filled in 2020, 2021, etc. What's that worth?--well, about 100K/position.

Meaning to say other institutions/hospitals are willing to fork out 100K for each position so that they can own the rights to those residents in the future.

Clearly there's a calculation of risk here, because in my opinion, if truly "perpetual", each spot would be worth more than a one time payment of 100K. Since the person--who one could argue will be as productive as an average PA--won't cost the institution anything in salary.

It looks like CMS wants to take back that funding, possibly to reallocate to other regions (the Northeast is relatively overfunded), or possibly just to save the salary costs in the future (more likely this). So there's a battle going on.

This is really inside baseball stuff and not that germane to applicants EXCEPT for applicants applying to programs at hospital systems that are financially weak--because you never know when that hospital is going to make a calculation that they want to auction off their residency programs for some cash.

 

[r9too]

So this is an aside into the world of residency financing. You wouldn't understand what this article is about without the information quoted above.

Judge puts freeze on sale of Hahnemann residency program — for now

Hahnemann had 550 residency spots, funded by Medicare "in perpetuity" (or at least until the rules change, which is really hard to execute).

The residents in those programs took the Medicare funding with them to other programs. So Hahnemann has no incoming Medicare funding for residents for the duration of those residents tenure at other programs (let's say between 1-5 yrs, since anyone in their last year of training will only take the Medicare funding with them to another institution for 1 year, anyone with 2 years left will take the Medicare funding for 2 years, etc).

But Hahnemann (or its creditors) still own the rights to future payments from Medicare for 550 residency positions that they would have filled in 2020, 2021, etc. What's that worth?--well, about 100K/position.

Meaning to say other institutions/hospitals are willing to fork out 100K for each position so that they can own the rights to those residents in the future.

Clearly there's a calculation of risk here, because in my opinion, if truly "perpetual", each spot would be worth more than a one time payment of 100K. Since the person--who one could argue will be as productive as an average PA--won't cost the institution anything in salary.

It looks like CMS wants to take back that funding, possibly to reallocate to other regions (the Northeast is relatively overfunded), or possibly just to save the salary costs in the future (more likely this). So there's a battle going on.

This is really inside baseball stuff and not that germane to applicants EXCEPT for applicants applying to programs at hospital systems that are financially weak--because you never know when that hospital is going to make a calculation that they want to auction off their residency programs for some cash.

So if Thomas Jefferson wins the appeal, does this mean they can theoretically expand their residency by 550 or so residents? And allocate those residency spots however they feel (I.e. 50% IM, 25% surgery, 25% rads)

 

[RadiologyPD]

Yes, or no. Depends on if TJU is over their current allocation. Remember, since the federal funding was capped at 1998 levels, some places have expanded using organizational funding. So if TJU is currently "self-funding" 550 spots (doubtful, but maybe a fraction of that--or not), then they could use the spots they bought to stop "self-funding" and not actually increase any more positions.

Also, keep in mind that the number of FTEs does not equate to the number of positions each year. Let's say the average residency is 4 yrs--then 550 spots = 137.5 more residency positions.

And finally, if there really is an increase in the number of positions (and not just an exchange of self-funding to Medicare funding), then each program that gets more positions has to get that increase in complement approved by the ACGME residency review committee of that specialty.

 

[Undercover_Brother]

Hello, I am a Radiology PD who was asked by an SDN administrator who is friend of one of my former fellows to participate in this thread. My understanding is that there may be at least one other PD (by the handle of "Radiology_Advisor") who will participate for now. Here is the request I received:

We are looking to increase attending presence on the forums especially in those specialties, such as DR, where students may not get a lot of exposure during the premed and med school years. Our "AMA" (Ask Me Anything") threads are immensely popular and of course, having PD input benefits all users as your experience and insight is something that we feel would be invaluable and not easily accessible elsewhere. Would you be interested in participating?

For now I prefer to stay anonymous, but it may help to know a bit about me. I graduated from a big Midwest state medical school almost 30 years ago and did my internship/residency out West. I did not entertain the idea of becoming a radiologist until my M3 year, after doing an elective in Radiology that I chose in order to be more familiar with how to get films/reports on my patients prior to my subsequent Internal Medicine and Surgery rotations (in the old days, students were judged by how good they were at getting what you needed from the radiology records department before rounds!). A big part of the reason I chose radiology is because I enjoyed the one-to-one teaching interactions that I saw the academic radiologists doing more than what I saw the academic internists and academic surgeons doing, and I wanted to stay in academics if possible. I've only been at two academic centers in my career--staying at the institution I did my residency & fellowship as an attending for about 5 years, then moving to my present position, which is also out West. I was a Chief Resident and on the residency selection committee at my former institution, and have been a fellowship program director and more recently am the residency program director at my current institution. As a result, I've been involved with the training of many radiologists.

It might have made more sense to start this thread after the upcoming Match, as I'm sure this forum will be buzzing with the results of the Match for a while, but I'm forging ahead now as requested. Heads up, I'm not going to engage into conversations about which program is better, or "chance me" requests, other than to perhaps direct those sorts of inquiries into more a more general discussion of underlying principles. Nevertheless, feel free to ask whatever, and if I don't particularly feel like I should engage or if I don't have a good answer, I won't hesitate to say so. Also, I may not be able to be as responsive as others, but I'll do my best.

Ok, that's it for now. Good luck to all of you who are awaiting the upcoming Match results!

hey doc. was wondering if we could your perspective on this thread here

Is radiology super competitive this year?

Lots of AOAs from my school applied this cycle to DR. According to the AMRAS chat, many people with 25x/26x and honors in 3rd year have received no or few interview invites. Could anyone close to the admissions process comment on the number and quality of applicants? Thanks.

forums.studentdoctor.net

 

[RadiologyPD]

seems same to me, but can't really tell from one program's experience...many programs wait until MSPE is released which just happened a few days ago

 

[loljkttyl]

Hello @RadiologyPD,
I'm lucky to be at a TY w a few blocks of elective time, planning for addl research + Step 3, but also wanted to browse some high-yield rads texts before starting R1 next year. Any suggestions for incoming residents? This is in light of the increasing Core exam failure rate that has me concerned.

Thank you for your advice + continued dedication to this thread.

During your medical school radiology elective, read Learning Radiology: Recognizing the Basics, not Squire's. During your transitional year, familiarize yourself with basic anatomy using online radiology atlases such as e-Anatomy (identify major organs on body CT +/- lymph node stations if ambitious) +/- headneckbrainspine.com (for neuroanatomy). If you want a head start on radiology, the most high-yield text is Core Radiology: A Visual Approach to Diagnostic Imaging. At your level, skim thoracic, gastrointestinal, genitourinary, and musculoskeletal sections as well as ultrasound; skip all other sections.

 

[jojo58]

Have you ever rescinded a match offer because an applicant failed a 4th year radiology rotation? My friend is in this boat. They failed due to missing too many days. They will still graduate on time. There is nothing mention of failures in their ERAS or any other "red flags".

 

[RadiologyPD]

Not possible to rescind a Match for that reason. The Match process is strict, programs have very little if any leverage to not go through with a Match. Candidates can quit but then they have no job, since they can't just go to another program.

 

[RadiologyPD]

I think I should let people following this thread know that I'm transitioning out of my role at PD over the next few months since that's the way we do things the place I am at. Fresh ideas, fresh leadership...totally makes sense. I'll still be super active training the fantastic residents I'm blessed to work with. I'll still chime in periodically, but at some point I just wont have the positional authority to authentically comment, at which point I'll stop.

So, along those lines, periodically over the next few posts, I'll make some comments to hopefully help everyone on the path to pursuing radiology residency. If you have any burning questions, now's the time to post them.

One thing to address is this notion that geographic interest in the location of a program somehow helps you.

Yes, it does--but as I've said before, it's only because programs want to interview people who will prioritize the geography of the program, if that is important to the applicant.

I will be the first to admit that the system is messed up. Programs receive hundreds more applicants than they have positions. Let's say the average applicant applies to 50 programs. Programs can only interview so many...and applicants can only seriously consider so many. So, programs DO consider geography when asking applicants to come interview, because it's one of the best "metrics" to ensure that the applicant (if interesting to the program) will actually want to go to that program.

Having said that, I'm amazed at how naive applicants are about this. They somehow think that programs somehow want to find applicants that have a geographic tie to their region. I get all kinds of LOIs telling me that the person really wants to settle in my area. The truth of the matter is that the best places DON'T REALLY CARE where you end up for your practice. I've indicated before that my program is west--so, to keep it in perspective, I really don't penalize applicants who want to end up in NYC for practice. We have sent trainees to NYC and they are happy as a clam at NYC. Great for me--when I go to NYC, I get to meet up with my former trainee in NYC and we reconnect. So fun.

Geography is most important FOR THE APPLICANT, not the program. Most applicants have some notion of where they want to end up, and if the person isn't aiming for an academic practice, then geography is a super important aspect of picking a program, because training in a region allows the applicant to network with regional practices, and chances are higher that people in those practices trained in the same area/same program.

If you are trying to sell yourself to a residency that isn't trying to create "academicians", then by all means emphasize the geography. If you are trying to sell yourself to a residency that has created a "brand" by distributing trainees across the country in academic practices or highly desirable private practices that try to get the best trained residents, then sell yourself as someone who wants the best training and is willing to go to the best place for fellowship and then for your practice--because that will be more interesting to these "high ranking" academic residencies than your desire to "stay in the Bay Area". Do you realize how many people want to "stay in the Bay Area?" If I had a dollar for everyone who told me that they want to settle in the "Bay Area", I'd be a millionaire.

That doesn't help, nor should you expect it to help.

Think about your college application. Do you think MIT cares that you want to settle in Boston? So tailor your message to the program based on the program. If the program is an "Aunt Minnie Semifinalist", don't think your desire to find a practice in that town helps you in any way.

 

[Dr. USMLE]

For the most part I agree with the above.

I will say that even at top programs (top 3), the faculty like to keep their trainees for a variety of reasons. Interest in settling in Boston or Baltimore is desirable to these programs. This is not only for potentially keeping you, but also because you're more invested, more likely to fit into the culture of the city and have a stronger support network. These factors do translate into a stronger residency and fellowship performance. Getting people who want to be there long-term (both at the institution and in the city) is valuable to the program.

People like me who train at top northeast programs and then move to Southern California are still valuable to these programs because it extends the network all the way to the other coast. However, it would have been more desirable for the programs for me to stay there long-term. They are explicit about this in their recruitment efforts.

 

[proth]

Do programs send out interviews to candidates they are not considering? I have gotten 30+ interviews as a weaker applicant which has been great, but is it possible that I am just ending up on the bottom of the rank lists at these programs?

 

[digoxin3443]

I had a burning question to ask you which I have gone back and forth over during interview season. I have a failed CS attempt followed by a pass on my application and the majority of the interviewers never ask about it. The rest of my application is strong. Sometimes I think ok well if they didn’t ask, they don’t care, so should I mention it? Other times I think they may care and so I clear it up before they ask, thinking that maybe they are testing me in some odd way by not asking and if I don’t clear it up then that looks bad. I just wanted to see what you think about this. Do you think I should do it ahead of time or only if asked directly/indirectly? Or should I just ask a generic question like do you have any questions about my application if they end up never talking about it in the interview? Or should I consider just telling the PD outright but not tell every single interviewer unless they ask? I’m stuck between a rock and a hard place, because I have no issue discussing it but I don’t know what is the correct route. I prefer not to shoot myself in the foot if it takes up precious interview time when people might not care as much. Thank you for your help.

 

[RadiologyPD]

Do programs send out interviews to candidates they are not considering? I have gotten 30+ interviews as a weaker applicant which has been great, but is it possible that I am just ending up on the bottom of the rank lists at these programs?

Not many. Maybe 1 or 2 to appease a faculty member or external friend who is pushing a candidate. Otherwise, interviews are way too much work and energy to expend for no good reason.

I had a burning question to ask you which I have gone back and forth over during interview season. I have a failed CS attempt followed by a pass on my application and the majority of the interviewers never ask about it. The rest of my application is strong. Sometimes I think ok well if they didn’t ask, they don’t care, so should I mention it? Other times I think they may care and so I clear it up before they ask, thinking that maybe they are testing me in some odd way by not asking and if I don’t clear it up then that looks bad. I just wanted to see what you think about this. Do you think I should do it ahead of time or only if asked directly/indirectly? Or should I just ask a generic question like do you have any questions about my application if they end up never talking about it in the interview? Or should I consider just telling the PD outright but not tell every single interviewer unless they ask? I’m stuck between a rock and a hard place, because I have no issue discussing it but I don’t know what is the correct route. I prefer not to shoot myself in the foot if it takes up precious interview time when people might not care as much. Thank you for your help.

ERAS changed the rules on programs this year. They are no longer flagging failing USMLE scores, so it is entirely possible that no one would notice. At the same time, it's awkward to bring up to a candidate even if you did know, because the truth is that programs are trying to sell themselves to you also. If they decided to interview you, they either didn't notice or decided the rest of your application was good enough to discount it. I'm not sure it is going to help much to explain it, so I wouldn't necessarily bring it up, but have a thoughtful response ready to go if it comes up.

 

[gilaze]

Not many. Maybe 1 or 2 to appease a faculty member or external friend who is pushing a candidate. Otherwise, interviews are way too much work and energy to expend for no good reason.



ERAS changed the rules on programs this year. They are no longer flagging failing USMLE scores, so it is entirely possible that no one would notice. At the same time, it's awkward to bring up to a candidate even if you did know, because the truth is that programs are trying to sell themselves to you also. If they decided to interview you, they either didn't notice or decided the rest of your application was good enough to discount it. I'm not sure it is going to help much to explain it, so I wouldn't necessarily bring it up, but have a thoughtful response ready to go if it comes up.

Do you consider ranking those candidates you invited just to appease a faculty member?

 

[OurDeadGrass]

.

 

[RadiologyPD]

Do you consider ranking those candidates you invited just to appease a faculty member?

As I've mentioned, once you get to the interview stage, it's like getting into the playoffs. Wild cards can win the Super Bowl. So, yes, everyone is considered and if you somehow hit it off with multiple interviewers, your outperformance in the interview will help. If there was no chance for ranking, then it would really be a waste of time for the program--I can't imagine any program going through that exercise for no reason.

what's a typical call schedule for attendings in academics and in pp? and how easy is it to sell call shifts and take a pay cut?

Really varies from place to place. Other than IR, I don't think "call" is a big detriment to academic diagnostic radiologists. Yes, it will be "worse" in some places than others--but we have you scut monkeys to rely on! (jk)

 

[Hedge Trimmer]

@RadiologyPD is there a way to PM you? I have a really unique application situation that I would appreciate some advice about from the perspective of a PD, but would also like to maintain anonymity from a public forum. If not, I totally understand. Thanks.

 

[digoxin3443]

I had a question regarding thank you note replies. I sent one to a program I really liked that I interviewed at a few weeks ago. I got the generic “good fit” reply from the PD. Do I assume that I am not going to be at the top of their ranks by that response since there was no rank to match response or anything like that? Thank you for your help.

 

[RadiologyPD]

I had a question regarding thank you note replies. I sent one to a program I really liked that I interviewed at a few weeks ago. I got the generic “good fit” reply from the PD. Do I assume that I am not going to be at the top of their ranks by that response since there was no rank to match response or anything like that? Thank you for your help.

Depends on the program and there's no way to know. Sorry, but it really is that idiosyncratic. For example, at my program, we don't believe in "rank to match" messages--so the response you received would be what we might send out to everyone (although truth be told, I tell applicants we won't respond to anything other than questions and they need not send anything but questions, but are welcome to send whatever they want--thank you's won't help them and won't hurt them).

 

[RadiologyPD]

Took step2 CS last week, results won't be in till early February right before rank lists. I know I'm neurotic but can't stop worrying that I failed. If my worst case scenario happens and I fail (gulp), I'd like to have a contingency plan. By end of interview season I'll have interviewed at close to 20 programs. What kind of back up plans should I have and will programs know immediately that I failed CS? Can I still match with a failed CS and take it after rank lists are out? The time between my expected score release and rank list is gonna be 1-2 weeks. No red flags on my application, overall solid applicant. Thanks @RadiologyPD

My guess is that they won't check your scores after you interview. I'll be honest, we don't. For many programs, the rank list is set immediately after the last interview, with very little "jockeying" around after that. Programs are as relieved as applicants when the last interview is over, no one wants to make more work for themselves by going back to ERAS to check CS scores.

 

[Stoop Kid]

Current M4 DR applicant in the middle of interview season. I've interviewed at 3 big name academic hospitals. Despite this I was still interested in a community program in my home town. I think the program is great (great residents, great mix of high volume and teaching, PD and chairman are motivated and awesome). Also, living in my home town would afford me the opportunity to continue a mentorship program for HS students I developed, give back to my community, and continue to help my med school develop a better curriculum (we currently rotate here).

However, I recently discovered that I really really like IR.

Since it is the most competitive fellowship along with the decreasing amount of spots each year, would you recommend ranking these big name institutions over the community program? Do these big name institutions afford that much of an advantage securing a fellowship spot?

Thank you so much for all this.

 

[RadiologyPD]

@RadiologyPD I'm currently a 3rd year at a mid-tier MD program and I feel like radiology is the specialty I want to go into. When should I reach out to my school's PD to set up a meeting to go over my application and stuff? I do have contact with some of the people in the department. I'm currently working with another radiology attending on a project and resident on a 2nd project. I have met the PD and chat with him a few times here and there but he's usually always busy and hard to track down.

Reach out after this year's Match is over. That PD is neck-deep in the current cycle, he/she isn't thinking about next year. Sometime before July should be fine.

As far as what to do, there's no special magic. Do well on your M3 clerkships, make some connections for a good letter.

 

[RadiologyPD]

Current M4 DR applicant in the middle of interview season. I've interviewed at 3 big name academic hospitals. Despite this I was still interested in a community program in my home town. I think the program is great (great residents, great mix of high volume and teaching, PD and chairman are motivated and awesome). Also, living in my home town would afford me the opportunity to continue a mentorship program for HS students I developed, give back to my community, and continue to help my med school develop a better curriculum (we currently rotate here).

However, I recently discovered that I really really like IR.

Since it is the most competitive fellowship along with the decreasing amount of spots each year, would you recommend ranking these big name institutions over the community program? Do these big name institutions afford that much of an advantage securing a fellowship spot?

If the community program has no reputation for excellence at all, then yes it will be a relative issue in moving on to a competitive independent IR program. If any of your "big name" academic hospitals has ESIR/independent pathway, consider strongly. If "big name" is truly "big name", then this will help even if there is no independent IR option there. Obviously, it would be nice to do ESIR during your residency. Also, keep in mind that in my experience, more than 50% of people who think they want to do IR end up not wanting to do IR after doing a couple of years of DR.

 

[Stoop Kid]

If the community program has no reputation for excellence at all, then yes it will be a relative issue in moving on to a competitive independent IR program. If any of your "big name" academic hospitals has ESIR/independent pathway, consider strongly. If "big name" is truly "big name", then this will help even if there is no independent IR option there. Obviously, it would be nice to do ESIR during your residency. Also, keep in mind that in my experience, more than 50% of people who think they want to do IR end up not wanting to do IR after doing a couple of years of DR.

Thank you for the reply. Thats a great point that most residents do not end up doing IR, and thats exactly why I did not apply to IR/DR. The both the academic programs and community program has ESIR.

Mind if I PM you with additional specifics?

 

[digoxin3443]

@RadiologyPD I had a pretty good interview day at a desired program to me, but one of the multiple interviewers was starting to ask some specific MR physics questions about one of my research projects. At one of them I simply said I cannot recall or do not fully understand the physics of the MR sequence as there are PhD’s in our lab who do work on that and some of it is complex for me.The interviewer agreed that MR physics can be really complicated. I have been thinking about this a lot as I am trying to decide what kind of impact it had on my chances. I know this is personal opinion, but I’m wondering what you would think if you were the person interviewing me. I was hoping this doesn’t drop me down the rankings. Thank you.

 

[RadChickE]

@RadiologyPD How should a candidate answer the "Tell me about Yourself " Question? I've had some additional experience in other fields prior to med school and thought that explaining both which skills I've gained and how they differentiate me would be a good response. May applicants seem to talk about themselves on a personal level...where they grew up, etc. What is your best suggestion? Thank you for your help.

 

[RadChickE]

Dear @RadiologyPD, Can you please explain the 2 digit score on the USMLE? Let's pretend it's 91. Is that the percentile? What does it mean? Thank you.

 

[RadiologyPD]

@RadiologyPD I had a pretty good interview day at a desired program to me, but one of the multiple interviewers was starting to ask some specific MR physics questions about one of my research projects. At one of them I simply said I cannot recall or do not fully understand the physics of the MR sequence as there are PhD’s in our lab who do work on that and some of it is complex for me.The interviewer agreed that MR physics can be really complicated. I have been thinking about this a lot as I am trying to decide what kind of impact it had on my chances. I know this is personal opinion, but I’m wondering what you would think if you were the person interviewing me. I was hoping this doesn’t drop me down the rankings. Thank you.

Can't worry about 1 interviewer grilling you, especially about MR Physics. I remember when I was interviewing (so long ago), a reasonably famous faculty member didn't seem to be impressed by my listed hobbies/interests, so I somehow blurted out that I enjoyed cooking (don't ask me why). While it may be true that I enjoyed the idea of cooking, I really didn't know how to cook, which became really obvious when he started digging deeper into that one. He definitely figured out I was totally bull****ting on that one, and I walked out thinking I'd tanked that interview. Ended up matching at a place higher than I had ranked that place, so whatever.

Try to be as resilient as you can in this process. You need resilience to get through the hundreds (if not thousands) of mistakes you will make (and suboptimal interactions you will have) over the next few years, and your career.

 

[RadiologyPD]

@RadiologyPD How should a candidate answer the "Tell me about Yourself " Question? I've had some additional experience in other fields prior to med school and thought that explaining both which skills I've gained and how they differentiate me would be a good response. May applicants seem to talk about themselves on a personal level...where they grew up, etc. What is your best suggestion? Thank you for your help.

Your response is fine. So is the other approach. That's an icebreaker question, don't read more into it than that.

 

[RadiologyPD]

Dear @RadiologyPD, Can you please explain the 2 digit score on the USMLE? Let's pretend it's 91. Is that the percentile? What does it mean? Thank you.

OK, now this is the type of question that you should be able to google.

The 2 digit score was abandoned for test administrations after 2013. I don't see them on the USMLE transcripts for applicants. They are only provided to the examinee and to state licensing authorities.

According to Wikipedia: Previously, a 2 digit score was also provided, but has since been eliminated. The two-digit score was normalized to the three-digit score such that a 75 was equal to the minimum passing score (currently 194) for the USMLE Step 1. Contrary to popular opinion, the two-digit score does not represent a percentile.

 

[RadiologyPD]

Dear @RadiologyPD, can you speak to your rank process and how much the interview changes your ranking? All my interviews have been very conversational and benign, with majority of time spent on hobbies and interests outside of medicine. Not sure how much a program is influenced by the interview and how much it changes things prior to the interview. I can certainly see how if you said something off-putting or can't hold a conversation how it negatively affects you, but my impression is vast majority of applicants are normal pleasant people and based on my interviews I can't see how program directors use these interviews to differentiate applicants.

For most candidates, I agree.

I have these conversations with my selection committee all the time, when one of them says that they "really connected" with an applicant or "could not engage" with an applicant. As a data afficianado, I find those assessments disconcerting.

To the extent that you believe in the "Blink" theory, the way we conduct residency interviews is similar to speed dating. You either really find someone off-putting, or you really dig someone, or "meh".

Same could be said about how applicants use the interview to vette programs. You use "Blink" to decide that you really connected with the program/residents, didn't like the residents/program, or "meh".

There is value to doing a gut-check, about a personal interaction or a program--but it can only take you so far. As long as you recognize the limitations, you can put it in the proper context. Truth be told, much of the interview process is designed to SELL YOU on the program, not evaluate you in any real sense (other than to weed out the strange ones).

 

[RadiologyPD]

@RadiologyPD how important are "you're my #1" letters closer to rank time? Do you recommend sending letters to program 2 and 3 on a rank list stating they'll be ranked "highly" or better off not communicating at all? Truth be told I'd be happy at any of my top 5 but don't know how to communicate that and if I even need to.

See post #20 and #51

"#1 letter" is a reasonable move--IMO, shouldn't help, but it may for some places

"Loved you" letter doesn't help at all

"#1 letter" to a place that is not "#1" is a dumb move